Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Surviving Sepsis Guidelines Updated

4,367 views

Published on

Preview from the 41th Society of Critical Care Medicine Meeting
Jun 16, 2012

Published in: Health & Medicine
  • About 2 years ago, I developed a severe case of vaginal yeast infection that would not let up. The itching, burning and swelling of my labia were simply unbearable. I have purchased several over-the-counter treatments, including Monistat cream to subside the symptoms. While it worked initially, eventually things wore off and left me with an even worse infection than before. The same goes for the antibiotics I took with the advice of my doctor. I felt horrible. After doing some research online, I guessed I had a yeast infection and purchased your program. The results were almost instantaneous. In less than 7 hours, I felt a tremendous relief. Two weeks later and I became completely free from the unbearable vaginal itching, burning, swelling and discharge. Using your methods, I have kept my chronic yeast infection at bay ever since. No more drugs or OTC�s for me. ▲▲▲ https://tinyurl.com/y3flbeje
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • the latest version of Surviving Sepsis Guidelines 2012
    http://www.slideshare.net/sunny_8162/surviving-sepsis-guidelines-updated
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here

Surviving Sepsis Guidelines Updated

  1. 1. SurvivingSepsisGuidelinesUpdatedPreview from the 41th Society of Critical Care Medicine Meeting Jun 16, 2012http://pulmccm.org/2012/critical-care-review/surviving-sepsis-guidelines-updated-at-sccm-meeting/
  2. 2. SIRS Sepsis Severe Sepsis Septic Shock SIRS withSystemic Inflammatory Response Organ Dysfunction Severe Sepsis and Hypotension Sepsis plus Syndrome Infection • • Elevated Creatinine (>2)Hypotension that does NOT • Temp < 36 ° C or > 38.3 ° C respond to fluid (500 cc bolus) • Elevated INR (DIC) • HR > 90 • Altered Mental Status (GCS <12) • RR > 20 or PCO2 < 32 • Elevated Lactate (>4) • WBC < 4K or > 12K or bands > 10% • Hypotension that responds to fluid Bone et al. Chest 1992;101:1644
  3. 3. 2001;345:1368-77.
  4. 4. Guide to Recommendations’Strengths and SupportingEvidence1 = strong recommendation2 = weak recommendation or suggestionA = good evidence from randomized trialsB = moderate strength evidence from small randomized trial(s) or multiple good observational trialsC = weak or absent evidence, mostly driven by consensus opinion
  5. 5. New FluidResuscitationRecommendationsUsing crystalloids like normal saline as the initial fluid resuscitation for people with severe sepsis.The initial fluid challenge should be 1L or more of crystalloid, and a minimum of 30 mL/kg of crystalloid (2.1 L in a 70 kg) in the first 4-6 hours. (Grade 1A)
  6. 6. New FluidResuscitationRecommendationsIncremental fluid boluses should be continued as long as patients continue to improve hemo- dynamically (in blood pressure, delta pulse pressure, or both) (Grade 1C)
  7. 7. New FluidResuscitationRecommendationsAdding albumin to initial fluid resuscitation with crystalloid for severe sepsis and septic shock (Grade 2B)Don’t using hetastarches/ hydroxyethyl starches greater than 200 kDa in molecular weight (Grade 1B)
  8. 8. New Recommendations for Vasopressors, Inotropes Using norepinephrine (Levophed) as the first choice for vasopressor therapy (Grade 1B). Vasopressin 0.03 units / minute is an alternative to norepinephrine, or may be added to it (Grade 2A) When a second agent is needed, epinephrine is weakly-recommended vasopressor choice (Grade 2B)
  9. 9. New Recommendations for Vasopressors, Inotropes Dopamine was only recommended in highly selected patients whose risk for arrhythmias was felt to be very low and who had a low heart rate and/or cardiac output (Grade 2C) Dobutamine is strongly recommended (by itself or in addition to a vasopressor) for patients with cardiac dysfunction as evidenced by high filling pressures and low cardiac output, or clinical signs of hypoperfusion after achievement of restoration of blood pressure with effective volume resuscitation (Grade 1C)
  10. 10. Corticosteroid RecommendationsDon’t providing intravenous corticosteroid therapy to patients for whom fluid resuscitation and vasopressors can restore an adequate blood pressure. For those with vasopressor-refractory septic shock, they recommend IV hydrocortisone in a continuous infusion totaling 200 mg/24 hrs (Grade 2C)
  11. 11. Mechanical Ventilation for ARDSFor patients with ARDS due to severe sepsis: Using higher levels of PEEP (Grade 2C) Recruitment maneuvers for patients with severe hypoxemia while receiving high PEEP and FiO2 (Grade 2C) Prone positioning for patients with PaO2/FiO2 ratios < 100 despite such maneuvers (Grade 2C)
  12. 12. Other New Surviving SepsisGuidelinesUsing normalization of lactate levels as an alternate goal in early goal- directed therapy for severe sepsis, if central venous oxygenation monitoring is not available (Grade 2C)
  13. 13. Other New Surviving SepsisGuidelinesFor patients at risk for fungal infection as a source for severe sepsis, checking one of the newer assays for invasive candidiasis such as 1,3-beta-D-glucan, mannan, or anti-mannan ELISA antibody testing (Grade 2B/C)
  14. 14. Other New Surviving SepsisGuidelinesWhen no infection can be found during empiric antibiotic therapy, consider using a low procalcitonin level as a supportive tool for the decision to stop antibiotics (Grade 2C).
  15. 15. The Surviving Sepsis project was criticized in the mid 2000s when it was revealed that Eli Lilly (makers of since-discontinued Xigris) provided a reported ~90% of the funding, without disclosure by the committee. Others (including the committee itself) felt such criticism was unfounded and unfair.

×